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Bricker JB, Mull KE, Sullivan BM, Forman EM, Lillis J, McTiernan A, Santiago-Torres M. Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial. Contemp Clin Trials 2023; 126:107091. [PMID: 36682490 PMCID: PMC9998365 DOI: 10.1016/j.cct.2023.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Evan M Forman
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; College of Psychology, California Northstate University, Elk Grove, CA, USA
| | - Anne McTiernan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington School of Public Health, Department of Epidemiology, USA; University of Washington School of Medicine, Department of Medicine, USA
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Alam MT, Veettil ST, Abdulmajeed J, Sait NS, Krishnan JI. A 4-year Retrospective Study on the Impact of the Dietary Program on Anthropometric and Metabolic Parameters among Overweight and Obese Subjects in Primary Health Care Centers in Qatar. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221120786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim. Obesity is a worldwide epidemic and one of the risk factors for many diseases including heart disease, diabetes mellitus, kidney disease, and cancer. The aim of this study was to review the impact of the local dietary program on anthropometric and metabolic parameters among overweight and obese subjects attending Primary Health Care Centers in Qatar from 2016 to 2019. Methods. A 4-year retrospective cohort study. Results. Among 10451 patients, the overall success rate of BMI reduction was 10% while 22.22% of population had ≥5% reduction in BMI from baseline. The median time for weight reduction was 3.2 years, with women showing earlier significant weight loss than men. The patients with 3–5 number of visits had earlier significant weight reduction than those with ≤3 visits and >5 number of visits. Greater weight reduction was seen in those with chronic diseases and who had constant follow up visits in the dietetic clinic during the study period. Conclusion. Our results are encouraging, showing improvement in the management of adult obesity with medical nutrition therapy through involvement and guidance in the community dietetic clinics. The dietetic clinic services could be an operative strategy to prevent expensive diabetic and cardiovascular events, mainly in high-risk patients.
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Affiliation(s)
- Muhammad T. Alam
- Airport Health Center, Consultant Family Medicine, Primary Health Care Corporation, Doha, Qatar
| | | | - Jazeel Abdulmajeed
- Strategy Planning & HI - Business & Health Intelligence Department, Primary Health Care Corporation, Doha, Qatar
| | - Neelufur S. Sait
- Dietician,Department of Operations, Airport Health Center,Primary Health Care Corporation, Doha, Qatar
| | - Jeyaram I. Krishnan
- Biostatistician Second \x{2022} Strategy Planning & HI - Business & Health Intelligence Department, Primary Health Care Corporation, Doha, Qatar
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Ross KM, Carpenter CA, Arroyo KM, Shankar MN, Yi F, Qiu P, Anthony L, Ruiz J, Perri MG. Impact of transition from face-to-face to telehealth on behavioral obesity treatment during the COVID-19 pandemic. Obesity (Silver Spring) 2022; 30:858-863. [PMID: 35037410 PMCID: PMC8957501 DOI: 10.1002/oby.23383] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study evaluated whether the transition of a face-to-face behavioral intervention to videoconferencing-based telehealth delivery during the COVID-19 pandemic resulted in significantly smaller weight losses than those typically observed in gold-standard, face-to-face programs. METHODS Participants were 160 adults with obesity (mean [SD] age = 49.2 [11.9] years, BMI = 36.1 [4.2] kg/m2 ) enrolled in two cohorts of a 16-week comprehensive weight-management program. Cohort 1 began in person and transitioned to telehealth (Zoom) delivery during week 11 of the intervention because of COVID-19; Cohort 2 was conducted completely remotely. A noninferiority approach (using a clinically relevant noninferiority margin of 2.5%) was used to assess whether the weight losses observed were inferior to the 8% losses from baseline typically produced by gold-standard, face-to-face lifestyle interventions. RESULTS From baseline to postintervention, participants lost an average of 7.4 [4.9] kg, representing a reduction of 7.2% [4.6%]. This magnitude of weight change was significantly greater than 5.5% (t[159] = 4.7, p < 0.001), and, thus, was within the proposed noninferiority margin. CONCLUSIONS These findings demonstrate that the results of behavioral weight-management interventions are robust, whether delivered in person or remotely, and that individuals can achieve clinically meaningful benefits from behavioral treatment even during a global pandemic. Pragmatic "lessons learned," including modified trial recruitment techniques, are discussed.
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Affiliation(s)
- Kathryn M. Ross
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Chelsea A. Carpenter
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Kelsey M. Arroyo
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Meena N. Shankar
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Fan Yi
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Peihua Qiu
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lisa Anthony
- Department of Computer and Information Science and Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Jaime Ruiz
- Department of Computer and Information Science and Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Michael G. Perri
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Delahanty LM, Wadden TA, Goodwin PJ, Alfano CM, Thomson CA, Irwin ML, Neuhouser ML, Crane TE, Frank E, Spears PA, Gillis BP, Hershman DL, Paskett ED, Hopkins J, Bernstein V, Stearns V, White J, Hudis C, Winer EP, Carey LA, Partridge AH, Ligibel JA. The Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention. Obesity (Silver Spring) 2022; 30:28-38. [PMID: 34932888 PMCID: PMC9186690 DOI: 10.1002/oby.23287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
The Breast Cancer Weight Loss (BWEL) trial is a randomized controlled trial designed to determine whether weight loss after a breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. The BWEL trial will compare the efficacy of a telephone-based weight-loss intervention plus health education materials versus health education materials alone on invasive disease-free survival in 3,181 women with stage II or III breast cancer and BMI > 27 kg/m2 . This report provides a detailed description of the goals and methods of the lifestyle intervention and the evidence supporting the intervention used in the BWEL trial. The intervention's primary goal for participants is to achieve and maintain a weight loss ≥ 10% of baseline weight through increased physical activity and caloric restriction. The evidence supporting the diet, physical activity, and behavioral components of this telephone-based weight-loss intervention, as well as strategies to promote participant engagement and retention, is described. The intervention is provided through 42 sessions delivered by trained health coaches over a 2-year period. If the BWEL lifestyle intervention is successful in improving cancer outcomes, then weight loss will be incorporated into the care of thousands of breast cancer patients.
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Affiliation(s)
- Linda M. Delahanty
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela J. Goodwin
- Mount Sinai Hospital/Lunenfeld Tanenbaum Research Institute, University of Toronto. Toronto, Ontario, Canada
| | - Catherine M. Alfano
- Northwell Health Cancer Institute; and Institute of Health System Science, Feinstein Institutes, for Medical Research; New York, NY, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Melinda L. Irwin
- Yale School of Public Health,Yale University, New Haven, CT, USA
| | - Marian L. Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tracy E. Crane
- Biobehavioral Health Sciences Division, College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Elizabeth Frank
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Patricia A. Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel, Hill, NC, USA
| | - Bonnie P. Gillis
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dawn L. Hershman
- Division of Medical Oncology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Judith Hopkins
- Novant Health Cancer Institute/SCOR NCORP, Novant Health Oncology Specialists, Winston-Salem, NC, USA
| | - Vanessa Bernstein
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, Victoria BC, Canada
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Julia White
- Department of Radiation Oncology, the Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Clifford Hudis
- American Society of Clinical Oncology, Alexandria, VA, USA and Department of Medicine Memorial Sloan Kettering Cancer Center, New York, NY, NY, USA
| | - Eric P. Winer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Lisa A. Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel, Hill, NC, USA
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Jennifer A. Ligibel
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
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Lewis E, Hassmén P, Pumpa KL. Participant perspectives of a telehealth trial investigating the use of telephone and text message support in obesity management: a qualitative evaluation. BMC Health Serv Res 2021; 21:675. [PMID: 34243772 PMCID: PMC8268488 DOI: 10.1186/s12913-021-06689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Quantitative evidence suggests that interventions involving telephone calls and text message are feasible and effective for improving lifestyle intervention adherence and clinical outcomes among adults with obesity. The aim of this article is to provide qualitative insight into the perspectives and experiences of participants who completed a telehealth trial exploring the use of telephone and text support as adjunctive tools to support a community-based obesity management program. Methods: Focus groups were conducted in order to evaluate program acceptability and overall participant perceptions of the clinical trial. Thematic content analysis was used to analyse the data, aided by the development of a thematic network. Results: The telehealth trial was well received. Participants found the telephone and text message support highly beneficial, providing encouragement, motivation and accountability via a simple and convenient mode of communication. Conclusions: These findings suggest a high degree of promise for the incorporation of telephone and text support in obesity management.
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Affiliation(s)
- Emily Lewis
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Building 29, Bruce, Canberra, ACT, 2617, Australia. .,Canberra Health Services, Division of Medicine, Chronic Disease Management Unit, Obesity Management Service, Canberra, Australia.
| | - Peter Hassmén
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Building 29, Bruce, Canberra, ACT, 2617, Australia.,Faculty of Health, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW, 2450, Australia
| | - Kate L Pumpa
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Building 29, Bruce, Canberra, ACT, 2617, Australia.,Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
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Szabo‐Reed AN, Martin LE, Hu J, Yeh H, Powell J, Lepping RJ, Patrician TM, Breslin FJ, Donnelly JE, Savage CR. Modeling interactions between brain function, diet adherence behaviors, and weight loss success. Obes Sci Pract 2020; 6:282-292. [PMID: 32523717 PMCID: PMC7278911 DOI: 10.1002/osp4.403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Obesity is linked to altered activation in reward and control brain circuitry; however, the associated brain activity related to successful or unsuccessful weight loss (WL) is unclear. METHODS Adults with obesity (N = 75) completed a baseline functional magnetic resonance imaging (fMRI) scan before entering a WL intervention (ie,3-month diet and physical activity [PA] program). We conducted an exploratory analysis to identify the contributions of baseline brain activation, adherence behavior patterns, and the associated connections to WL at the conclusion of a 3-month WL intervention. Food cue-reactivity brain regions were functionally identified using fMRI to index brain activation to food vs nonfood cues. Food consumption, PA, and class attendance were collected weekly during the 3-month intervention. RESULTS The left middle frontal gyrus (L-MFG, BA 46) and right middle frontal gyrus (R-MFG; BA 9) were positively activated when viewing food compared with nonfood images. Structural equation modeling with bootstrapping was used to investigate a hypothesized path model and revealed the following significant paths: (1) attendance to 3-month WL, (2) R-MFG to attendance, and (3) indirect effects of R-MFG through attendance on WL. CONCLUSION Findings suggest that brain activation to appetitive food cues predicts future WL through mediating session attendance, diet, and PA. This study contributes to the growing evidence of the importance of food cue reactivity and self-regulation brain regions and their impact on WL outcomes.
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Affiliation(s)
- Amanda N. Szabo‐Reed
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansas
| | - Laura E. Martin
- Department of Population Health HealthUniversity of Kansas Medical CenterKansas CityKansas
- Hoglund Brain Imaging CenterUniversity of Kansas Medical CenterKansas CityKansas
| | - Jinxiang Hu
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Hung‐Wen Yeh
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Joshua Powell
- Graduate School of Social WorkUniversity of DenverDenverColorado
| | - Rebecca J. Lepping
- Hoglund Brain Imaging CenterUniversity of Kansas Medical CenterKansas CityKansas
| | - Trisha M. Patrician
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
| | - Florance J. Breslin
- Center for Brain, Biology and BehaviorUniversity of Nebraska‐LincolnLincolnNebraska
| | - Joseph E. Donnelly
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansas
| | - Cary R. Savage
- Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityKansas
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Adding Telephone and Text Support to an Obesity Management Program Improves Behavioral Adherence and Clinical Outcomes. A Randomized Controlled Crossover Trial. Int J Behav Med 2020; 26:580-590. [PMID: 31512155 DOI: 10.1007/s12529-019-09815-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Behavioral treatment strategies improve adherence to lifestyle intervention for adults with obesity, but can be time and resource intensive when delivered via traditional face-to-face care. This study aimed to investigate the efficacy and optimal timing of using telephone calls and text message as adjunctive tools to support a community-based obesity management program. METHOD This 8-month randomized controlled crossover trial recruited 61 adults with class III obesity (BMI > 40 kg/m2) enrolled in a publicly funded obesity management service (OMS). Participants were randomly assigned to receive telephone and text message support in addition to standard OMS care, or standard OMS care alone. After 4 months, participants crossed over to the alternative sequence. The technological support was based on self-determination theory. Outcome measures included diet, physical activity, anthropometry, self-efficacy, and treatment self-regulation. RESULTS Telephone and text message support improved lifestyle intervention adherence and clinical outcomes when compared with standard care. Participants who received the intervention in the first 4-month period lost 4.87 kg, compared with no weight loss (+ 0.38 kg) in the standard care only group. There was no evidence to indicate an optimal timing of the intervention, with both groups achieving significant results by the end of the intervention. CONCLUSION These results suggest a high degree of promise for the incorporation of telephone and text message support into community-based obesity management services. The findings have the potential to improve existing practices and reduce the burden on the health care system by demonstrating a resource-effective improvement to obesity management service delivery.
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Unick JL, Pellegrini CA, Dunsiger SI, Demos KE, Thomas JG, Bond DS, Webster J, Wing RR. DIAL now protocol: A randomized trial examining the provision of phone coaching to those with sub-optimal early weight loss during an Internet weight management program. Contemp Clin Trials 2020; 90:105953. [PMID: 32017994 PMCID: PMC7071958 DOI: 10.1016/j.cct.2020.105953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND While low-intensity Internet-delivered weight loss (IDWL) programs are efficacious, many patients fail to achieve clinically significant weight loss (WL). Given the positive association between 4-week and post-treatment WL, providing a more intensive intervention for those with sub-optimal 4-week WL may improve outcomes for a greater proportion of individuals. This stepped-care approach would minimize cost by reserving more aggressive treatment for those with sub-optimal early WL. OBJECTIVE This randomized trial examines whether the provision of brief or extended phone coaching for those with sub-optimal early WL improves 4- and 12-month WL when compared to no coaching. Secondary aims include examination of cost/kg WL and intervention engagement. METHODS 450 individuals (age 18-70 years, BMI: 25-45 kg/m2) will be randomized to: 1) IDWL+3 weeks of coaching ('Brief'), 2) IDWL+12 weeks of coaching ('Extended'), or 3) IDWL only ('Control'). All individuals will receive a 4-month IDWL program followed by an 8-month IDWL maintenance program. At week 4, individuals will be classified as early sub-optimal responders (<4% WL) or initial responders (≥4% WL). Individuals with sub-optimal early WL randomized to 'Brief' or 'Extended' will receive 3 and 12 weeks of phone coaching respectively, starting at week 5. Those with sub-optimal early WL randomized to 'Control', and initial responders will not receive any coaching. Assessments will occur at 4 and 12 months. DISCUSSION Study findings can inform the development of more effective IDWL programs. This model which provides additional support to those with sub-optimal early WL can easily be translated into healthcare and community settings.
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Affiliation(s)
- Jessica L Unick
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA.
| | - Christine A Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, USA
| | - Kathryn E Demos
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - J Graham Thomas
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Dale S Bond
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jennifer Webster
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Rena R Wing
- Warren Alpert Medical School at Brown University and The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI, USA
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Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. AMERICAN PSYCHOLOGIST 2020; 75:235-251. [PMID: 32052997 PMCID: PMC7027681 DOI: 10.1037/amp0000517] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight and Obesity in Adults (hereafter, Obesity Guidelines) as a framework, this article reviews the principal components of comprehensive lifestyle modification, which include diet, physical activity, and behavior therapy. To lose weight, the Obesity Guidelines recommend participation for 6 months in high-intensity programs that provide 14 or more counseling sessions with a trained interventionist. When provided face-to-face individual or group treatment, participants lose up to 8 kg (8% of weight) in 6 months and experience improvements in cardiovascular disease risk factors and quality of life. To prevent weight regain, the Obesity Guidelines recommend participation for 1 year in weight-loss-maintenance programs that provide at least monthly counseling. High levels of physical activity, frequent monitoring of body weight, and consumption of a reduced-calorie diet are associated with long-term weight loss. Investigators currently are seeking to increase the availability of lifestyle modification by delivering it in community-based programs, as well as on digital platforms (e.g., Internet and Smartphone). Digitally delivered programs lower costs and expand treatment reach; their efficacy is likely to improve further with the addition of new technologies for monitoring food intake, activity, and weight. Ultimately, to improve long-term weight management, individual lifestyle counseling must be joined with collective and institutional efforts to improve the nation's eating and activity environments. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Jena S Tronieri
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
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Bourke S, Morton JM, Williams P. Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults. J Obes 2020; 2020:8026016. [PMID: 32318289 PMCID: PMC7157789 DOI: 10.1155/2020/8026016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/10/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described. METHODS Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants. RESULTS Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were -6.5 ± 0.03 kg, -7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; -7.7 ± 0.04 kg, -8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and -7.7 ± 0.1 kg, -8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets. CONCLUSION A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.
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Affiliation(s)
- Sean Bourke
- JumpstartMD, 350 Lorton Ave, Burlingame, CA 94010, USA
| | - John Magaña Morton
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Paul Williams
- Childrens Hospital Oakland Research Institute, Oakland, CA, USA
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Delahanty LM, Chang Y, Levy DE, Porneala B, Dushkin A, Bissett L, Goldman V, Perrotta J, Rodriguez AR, Chase B, LaRocca R, Wheeler A, Wexler DJ. Design and participant characteristics of a primary care adaptation of the Look AHEAD Lifestyle Intervention for weight loss in type 2 diabetes: The REAL HEALTH-diabetes study. Contemp Clin Trials 2018; 71:9-17. [PMID: 29803816 DOI: 10.1016/j.cct.2018.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS The REAL HEALTH -Diabetes Study is a practice-based clinical trial that adapted the Look AHEAD lifestyle intervention for implementation in primary care settings. The trial will compare the effectiveness and cost-effectiveness of in-person group lifestyle intervention, telephone group lifestyle intervention, and individual medical nutrition therapy (MNT), the current recommended standard of care in type 2 diabetes. The primary outcome is percent weight loss at 6 months with outcomes also measured at 12, 18, 24 (intervention completion), and 36 months. Here, we describe the adaptation, trial design, implementation strategies, and baseline characteristics of enrolled participants. METHODS The study is a three-arm, patient-level, randomized trial conducted in three community health centers (CHCs) and one diabetes practice affiliated with one academic medical center. RESULTS The study used existing clinical infrastructure to recruit participants from study sites. Strategies for successful conduct of the trial included partnering with health-center based co-investigator clinicians, engaging primary care providers, and accommodating clinical workflows. Of 248 eligible patients who attended a screening visit, 211 enrolled, with 70 randomly assigned to in-person group lifestyle intervention, 72 to telephone group lifestyle intervention, and 69 to MNT. The cohort was 55% female, 29% non-white, with mean age 62 years and mean BMI 35 kg/m2. Enrollment rates were higher at CHC sites. CONCLUSIONS A practice-based randomized trial of a complex behavioral lifestyle intervention for type 2 diabetes can be implemented in community health and usual clinical settings. Participant and provider engagement was higher at local CHC sites reflecting the study implementation focus. CLINICAL TRIAL REGISTRATION NCT02320253.
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Affiliation(s)
- Linda M Delahanty
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Douglas E Levy
- Harvard Medical School, Boston, MA, United States; Mongan Institute Health Policy Center, MGH, Boston, MA, United States
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Amy Dushkin
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Laurie Bissett
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Valerie Goldman
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Jeanna Perrotta
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Anthony Romeo Rodriguez
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States
| | - Barbara Chase
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States; MGH Chelsea Health Center, Boston, MA, United States
| | - Rajani LaRocca
- Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States; MGH Charlestown Health Center, Boston, MA, United States
| | - Amy Wheeler
- Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States; MGH Revere Health Center, Boston, MA, United States
| | - Deborah J Wexler
- Massachusetts General Hospital (MGH) Diabetes Research Center, Diabetes Unit, Department of Medicine, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Gotthelf L, Chen YT, Rajagopalan S, Wu ECT, Doshi I, Addy C. High intensity lifestyle intervention and long-term impact on weight and clinical outcomes. PLoS One 2018; 13:e0195794. [PMID: 29668741 PMCID: PMC5905976 DOI: 10.1371/journal.pone.0195794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/09/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obesity increases the risk for diabetes and cardiovascular events, with a corresponding growth in medical costs. High intensity lifestyle intervention (HILI) is the cornerstone for weight management. We assessed the effectiveness of clinic-based HILI on weight loss and associated clinical outcomes by duration of program participation and comorbid conditions. METHODS This was a retrospective cohort study of patients who enrolled in HILI weight management programs at Health Management Resources (HMR) clinics located across the U.S. Patients completed health risk assessments (HRA) and were enrolled for up to 24 months at the time of follow-up HRA. HMR programs provide weekly group coaching to achieve reduced calorie intake, increased fruit/vegetable intake, and physical activity ≥2,000 kcal/wk. A Markov model predicted avoidance of diabetes and cardiovascular events and projected cost savings due to weight loss. RESULTS Of the 500 patients included in the analysis, 67% were female and mean age was 54.1 years (s.d. 11.6). The baseline weight and BMI were 243.5 lbs (range 144.0-545.0) and 38.8 kg/m2 (range 25.4-85.0), respectively. Overall, patients lost an average of 47.4 lbs (18.9% of initial body weight [IBW]); the amount of weight loss was consistent among those with diabetes/pre-diabetes (50%), high/moderate risk for dyslipidemia (60%), hypertension/pre-hypertension (86%), and severe obesity (37%). The mean IBW lost was 16.4%, 19.3%, 20.7% for ≤6 months (n = 165), 7-12 months (n = 140), 13-24 months (n = 195) of program participation, respectively. The simulation model estimated 22 diabetes and 30 cardiovascular events and $1,992,370 medical costs avoided over 5 years in the 500 patients evaluated. CONCLUSION Patients in the HMR clinic-based HILI program achieved substantial weight loss regardless of duration of program participation, risk profile and comorbid status. The HMR program could be an effective strategy to prevent costly diabetes and cardiovascular events, particularly in high risk patients.
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Affiliation(s)
- Linda Gotthelf
- HMR Weight Management Services Corp., Boston, Massachusetts, United States of America
| | - Ya-Ting Chen
- Center for Outcomes Research and Real-World Evidence, Healthcare Services and Solutions, Merck & Co., Inc, Kenilworth, New Jersey, United States of America
| | | | - Elise Chi-Tao Wu
- Center for Outcomes Research and Real-World Evidence, Economics and Data Science, Merck & Co., Inc, Kenilworth, New Jersey, United States of America
| | - Ishita Doshi
- Center for Outcomes Research and Real-World Evidence, Study Management, Merck & Co., Inc, Kenilworth, New Jersey, United States of America
| | - Carol Addy
- HMR Weight Management Services Corp., Boston, Massachusetts, United States of America
- * E-mail:
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Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, Kushner RF, Daniels SR, Wadden TA, Tsai AG, Hu FB, Jakicic JM, Ryan DH, Wolfe BM, Inge TH. The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocr Rev 2018; 39:79-132. [PMID: 29518206 PMCID: PMC5888222 DOI: 10.1210/er.2017-00253] [Citation(s) in RCA: 429] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/19/2022]
Abstract
The prevalence of obesity, measured by body mass index, has risen to unacceptable levels in both men and women in the United States and worldwide with resultant hazardous health implications. Genetic, environmental, and behavioral factors influence the development of obesity, and both the general public and health professionals stigmatize those who suffer from the disease. Obesity is associated with and contributes to a shortened life span, type 2 diabetes mellitus, cardiovascular disease, some cancers, kidney disease, obstructive sleep apnea, gout, osteoarthritis, and hepatobiliary disease, among others. Weight loss reduces all of these diseases in a dose-related manner-the more weight lost, the better the outcome. The phenotype of "medically healthy obesity" appears to be a transient state that progresses over time to an unhealthy phenotype, especially in children and adolescents. Weight loss is best achieved by reducing energy intake and increasing energy expenditure. Programs that are effective for weight loss include peer-reviewed and approved lifestyle modification programs, diets, commercial weight-loss programs, exercise programs, medications, and surgery. Over-the-counter herbal preparations that some patients use to treat obesity have limited, if any, data documenting their efficacy or safety, and there are few regulatory requirements. Weight regain is expected in all patients, especially when treatment is discontinued. When making treatment decisions, clinicians should consider body fat distribution and individual health risks in addition to body mass index.
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Affiliation(s)
- George A Bray
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - William E Heisel
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | - Ashkan Afshin
- Institute of Health Metrics and Evaluation University of Washington, Seattle, Washington
| | | | - William H Dietz
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Michael Long
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | | | - Stephen R Daniels
- Department of Pediatrics, University of Colorado Children Hospital, Denver, Colorado
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Adam G Tsai
- Kaiser Permanente Colorado, Denver, Colorado
| | - Frank B Hu
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Donna H Ryan
- Department of Clinical Obesity, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Bruce M Wolfe
- Oregon Health and Science University, Portland, Oregon
| | - Thomas H Inge
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
- Children’s Hospital Colorado, Aurora, Colorado
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14
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Shaw Tronieri J, Wadden TA, Berkowitz RI, Chao AM, Pearl RL, Alamuddin N, Leonard SM, Carvajal R, Bakizada ZM, Pinkasavage E, Gruber KA, Walsh OA, Alfaris N. A Randomized Trial of Lorcaserin and Lifestyle Counseling for Maintaining Weight Loss Achieved with a Low-Calorie Diet. Obesity (Silver Spring) 2018; 26:299-309. [PMID: 29288545 DOI: 10.1002/oby.22081] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Improving the maintenance of lost weight remains a critical challenge, which can be addressed by long-term behavioral and/or pharmacological interventions. METHODS This study investigated the efficacy of combined behavioral and pharmacological treatment in facilitating weight loss maintenance (WLM) in 137 adults (86.1% female; 68.6% black; BMI = 37.0 ± 5.6 kg/m2 ) who had lost ≥ 5% of initial weight during a 14-week low-calorie diet (LCD) program (mean = 9.3 ± 2.9%). Participants were randomly assigned to lorcaserin (10 mg twice a day) or placebo and were provided 16 group WLM counseling sessions over 52 weeks. RESULTS At 24 weeks post randomization, more lorcaserin-treated than placebo-treated participants maintained a ≥ 5% loss (73.9% vs. 57.4%; P = 0.033), and the lorcaserin-treated participants lost an additional 2.4 ± 0.8 kg versus a 0.6 ± 0.8 kg gain for placebo (P = 0.010). However, at week 52, groups did not differ on either co-primary outcome; 55.1% and 42.6%, respectively, maintained ≥ 5% loss (P = 0.110), with gains from randomization of 2.0 ± 0.8 kg and 2.5 ± 0.8 kg (P = 0.630), respectively. From the start of the LCD, groups maintained reductions of 7.8% and 6.6%, respectively (P = 0.318). CONCLUSIONS Combined behavioral and pharmacological treatment produced clinically meaningful long-term weight loss in this group of predominantly black participants. Lorcaserin initially improved upon weight loss achieved with WLM counseling, but this advantage was not maintained at 1 year.
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Affiliation(s)
- Jena Shaw Tronieri
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert I Berkowitz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Psychiatry, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ariana M Chao
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Rebecca L Pearl
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Naji Alamuddin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sharon M Leonard
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ray Carvajal
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Zayna M Bakizada
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Emilie Pinkasavage
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kathryn A Gruber
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Olivia A Walsh
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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15
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Flodgren G, Gonçalves‐Bradley DC, Summerbell CD. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity. Cochrane Database Syst Rev 2017; 11:CD000984. [PMID: 29190418 PMCID: PMC6486102 DOI: 10.1002/14651858.cd000984.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing globally, an increase which has major implications for both population health and costs to health services. This is an update of a Cochrane Review. OBJECTIVES To assess the effects of strategies to change the behaviour of health professionals or the organisation of care compared to standard care, to promote weight reduction in children and adults with overweight or obesity. SEARCH METHODS We searched the following databases for primary studies up to September 2016: CENTRAL, MEDLINE, Embase, CINAHL, DARE and PsycINFO. We searched the reference lists of included studies and two trial registries. SELECTION CRITERIA We considered randomised trials that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in children and adults with overweight or obesity. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane when conducting this review. We report the results for the professional interventions and the organisational interventions in seven 'Summary of findings' tables. MAIN RESULTS We identified 12 studies for inclusion in this review, seven of which evaluated interventions targeting healthcare professional and five targeting the organisation of care. Eight studies recruited adults with overweight or obesity and four recruited children with obesity. Eight studies had an overall high risk of bias, and four had a low risk of bias. In total, 139 practices provided care to 89,754 people, with a median follow-up of 12 months. Professional interventions Educational interventions aimed at general practitioners (GPs), may slightly reduce the weight of participants (mean difference (MD) -1.24 kg, 95% confidence interval (CI) -2.84 to 0.37; 3 studies, N = 1017 adults; low-certainty evidence).Tailoring interventions to improve GPs' compliance with obesity guidelines probably leads to little or no difference in weight loss (MD 0.05 (kg), 95% CI -0.32 to 0.41; 1 study, N = 49,807 adults; moderate-certainty evidence).It is uncertain if providing doctors with reminders results in a greater weight reduction than standard care (men: MD -11.20 kg, 95% CI -20.66 kg to -1.74 kg, and women: MD -1.30 kg, 95% CI [-7.34, 4.74] kg; 1 study, N = 90 adults; very low-certainty evidence).Providing clinicians with a clinical decision support (CDS) tool to assist with obesity management at the point of care leads to little or no difference in the body mass index (BMI) z-score of children (MD -0.08, 95% CI -0.15 to -0.01 in 378 children; moderate-certainty evidence), CDS tools may lead to little or no difference in weight loss in adults: MD -0.095 kg (-0.21 lbs), P = 0.47; 1 study, N = 35,665; low-certainty evidence. Organisational interventions Adults with overweight or obesity may lose more weight if the care was provided by a dietitian (by -5.60 kg, 95% CI -4.83 kg to -6.37 kg) or by a doctor-dietitian team (by -6.70 kg, 95% CI -7.52 kg to -5.88 kg; 1 study, N = 270 adults; low-certainty evidence). Shared care leads to little or no difference in the BMI z-score of children with obesity (adjusted MD -0.05, 95% CI -0.14 to 0.03; 1 study, N = 105 children; low-certainty evidence).Organisational restructuring of the delivery of primary care (i.e. introducing the chronic care model) may result in a slightly lower increase in the BMI of children who received care at intervention clinics (BMI change: adjusted MD -0.21, 95% CI -0.50 to 0.07; 1 study, unadjusted MD -0.18, 95% CI -0.20 to -0.16; N=473 participants; moderate-certainty evidence).Mail and phone interventions probably lead to little or no difference in weight loss in adults (mean weight change (kg) using mail: -0.36, 95% CI -1.18 to 0.46; phone: -0.44, 95% CI -1.26 to 0.38; 1 study, N = 1801 adults; moderate-certainty evidence). Care delivered by a nurse at a primary care clinic may lead to little or no difference in the BMI z-score in children (MD -0.02, 95% CI -0.16 to 0.12; 1 study, N = 52 children; very low-certainty evidence).Two studies reported data on cost effectiveness: one study favoured mail and standard care over telephone consultations, and the other study achieved weight loss at a modest cost in both intervention groups (doctor and doctor-dietitian). One study of shared care reported similar adverse effects in both groups. AUTHORS' CONCLUSIONS We found little convincing evidence for a clinically-important effect on participants' weight or BMI of any of the evaluated interventions. While pooled results from three studies indicate that educational interventions targeting healthcare professionals may lead to a slight weight reduction in adults, the certainty of these results is low. Two trials evaluating CDS tools (unpooled results) for improved weight management suggest little or no effect on weight or BMI change in adults or children with overweight or obesity. Evidence for all the other interventions evaluated came mostly from single studies. The certainty of the included evidence varied from moderate to very low for the main outcomes (weight and BMI). All of the evaluated interventions would need further investigation to ascertain their strengths and limitations as effective strategies to change the behaviour of healthcare professionals or the organisation of care. As only two studies reported on cost, we know little about cost effectiveness across the evaluated interventions.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthDivision for Health ServicesPilestredet Park 7OsloNorway0176
| | | | - Carolyn D Summerbell
- Queen's Campus, Durham UniversitySchool of Medicine, Pharmacy and Health, Wolfson Research InstituteUniversity BoulevardThornabyStockton‐on‐TeesUKTS17 6BH
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Chao AM, Srinivas SK, Studt SK, Diewald LK, Sarwer DB, Allison KC. A Pilot Randomized Controlled Trial of a Technology-Based Approach for Preventing Excess Weight Gain during Pregnancy among Women with Overweight. Front Nutr 2017; 4:57. [PMID: 29214155 PMCID: PMC5702628 DOI: 10.3389/fnut.2017.00057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/08/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Overweight/obesity and excess weight gain during pregnancy are associated with adverse maternal and neonatal outcomes. Few interventions have been effective in limiting gestational weight gain among women with overweight or obesity. This pilot, randomized clinical trial compared treatment as usual (TAU) to a lifestyle modification program delivered via phone for the prevention of excess gestational weight gain in women who had overweight or obesity. METHODS Participants included 41 pregnant women with a body mass index (BMI) ≥ 25 kg/m2 (mean age = 28.7 ± 5.8 years; mean pre-gravid BMI = 31.2 ± 6.2 kg/m2; 54% black, 39% white). The intervention group (n = 20) received weekly telephone counseling sessions and used WiFi scales to monitor their weight from weeks 16 to 36 of pregnancy. We compared differences in weight and birth outcomes for the intervention vs. the TAU group (n = 21). RESULTS The intervention and TAU groups did not differ with respect to: gestational weight gain (15.5 ± 5.3 vs. 13.3 ± 6.8 kg, respectively); proportion gaining above the 2009 Institute of Medicine recommended weight range (83 vs. 70%); and weight gain from pre-pregnancy weight to 6 weeks postpartum (4.8 ± 4.6 vs. 3.0 ± 5.5 kg). Other birth and health outcomes also did not differ. CONCLUSION A telemedicine intervention designed to decrease logistical burden on participants was not more successful in reducing excessive weight gain during pregnancy as compared to TAU. Future studies should examine more intensive forms of remote treatment beginning earlier in pregnancy as well as interventions promoting a healthy weight prior to pregnancy.
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Affiliation(s)
- Ariana M. Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, United States
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Stacia K. Studt
- New York City Department of Health and Mental Hygiene, New York, NY, United States
| | - Lisa K. Diewald
- Villanova University College of Nursing, Villanova, PA, United States
| | - David B. Sarwer
- Center for Obesity Research and Education, Department of Social and Behavioral Science, Temple University College of Public Health, Philadelphia, PA, United States
| | - Kelly C. Allison
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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Tronieri JS, Alfaris N, Chao AM, Pearl RL, Alamuddin N, Bakizada ZM, Berkowitz RI, Wadden TA. Lorcaserin plus lifestyle modification for weight loss maintenance: Rationale and design for a randomized controlled trial. Contemp Clin Trials 2017; 59:105-112. [PMID: 28600158 DOI: 10.1016/j.cct.2017.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND/AIMS Few studies have examined the efficacy of recently approved medications for chronic weight management in facilitating the maintenance of lost weight. This paper provides an overview of the design and rationale for a trial investigating whether lorcaserin, when combined with behavioral weight loss maintenance sessions (WLM), will facilitate the maintenance of losses of ≥5% of initial weight. METHODS In this two-phase trial, participants with obesity will enroll in a 14-week run-in diet program consisting of weekly group lifestyle modification sessions and a 1000-1200kcal/d meal replacement diet. Participants who complete this weight induction phase and lose at least 5% of initial weight will then be randomized to 52weeks of WLM plus lorcaserin or WLM plus placebo. We hypothesize that at 52weeks post randomization, participants assigned to WLM plus lorcaserin will achieve significantly better maintenance of the prior 5% weight loss. RESULTS We will recruit 182 adults with obesity to participate in the diet run-in, 136 of whom (75%) are expected to become eligible for the randomized controlled trial. Co-primary outcomes include the percentage of participants who maintain a loss of at least 5% of initial weight at week 52 and change in weight (kg) from randomization to week 52. CONCLUSIONS This two-phase design will allow us to determine the potential efficacy of chronic weight management using lorcaserin for maintaining initial losses of at least 5% body weight, induced by the use of a structured meal-replacement diet. This combined approach holds promise of achieving larger long-term weight losses. CLINICAL TRIAL REGISTRATION NCT02388568 on ClinicalTrials.gov.
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Affiliation(s)
- Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States.
| | - Nasreen Alfaris
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Ariana M Chao
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Department of Family and Community Health, School of Nursing, University of Pennsylvania, United States
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Naji Alamuddin
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Institute for Diabetes, Obesity, and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States
| | - Zayna M Bakizada
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Robert I Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States; Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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18
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Webb VL, Wadden TA. Intensive Lifestyle Intervention for Obesity: Principles, Practices, and Results. Gastroenterology 2017; 152:1752-1764. [PMID: 28192109 DOI: 10.1053/j.gastro.2017.01.045] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 01/25/2023]
Abstract
Using the Guidelines for the Management of Overweight and Obesity in Adults as a framework, this article reviews intensive lifestyle interventions for weight loss. The Guidelines recommend a minimum of 6 months of high-intensity, comprehensive lifestyle intervention, consisting of a reduced-calorie diet, increased physical activity, and behavior therapy. Persons with obesity typically lose approximately 8 kg (approximately 8% of initial weight) with this approach, accompanied by improvements in health and quality of life. To prevent weight regain, the Guidelines recommend a 1-year weight loss maintenance program that includes at least monthly counseling with a trained interventionist. Lifestyle interventions usually are delivered in-person; however, treatment increasingly is being disseminated through community- and commercial-based programs, as well as delivered by telephone, Internet, and smartphone platforms. These latter modalities expand treatment reach but usually produce smaller weight losses than in-person interventions. The review concludes with an examination of challenges in weight management.
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Affiliation(s)
- Victoria L Webb
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Abstract
Advisory panels encourage persons with obesity to lose 5% to 10% of body weight, which can be achieved with dietary change, increased physical activity, and behavioral therapy. Patients participate in weekly individual or group treatment sessions delivered in-person or by telephone. Large-scale trials have demonstrated the effectiveness of this approach, with resulting improvement in cardiovascular disease risk factors. Weight regain is common. Several strategies improve weight loss maintenance, including monthly or more frequent follow-up with an interventionist. Digitally-delivered approaches are promising because they have the potential to reach more individuals.
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Affiliation(s)
- Naji Alamuddin
- Division of Endocrinology, Diabetes, and Metabolism; and Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3025, Philadelphia, PA 19104, USA.
| | - Thomas A Wadden
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA
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20
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Ross KM, Wing RR. Impact of newer self-monitoring technology and brief phone-based intervention on weight loss: A randomized pilot study. Obesity (Silver Spring) 2016; 24:1653-9. [PMID: 27367614 PMCID: PMC4963263 DOI: 10.1002/oby.21536] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/12/2016] [Accepted: 04/01/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Despite the proliferation of newer self-monitoring technology (e.g., activity monitors and smartphone apps), their impact on weight loss outside of structured in-person behavioral intervention is unknown. METHODS A randomized, controlled pilot study was conducted to examine efficacy of self-monitoring technology, with and without phone-based intervention, on 6-month weight loss in adults with overweight and obesity. Eighty participants were randomized to receive standard self-monitoring tools (ST, n = 26), technology-based self-monitoring tools (TECH, n = 27), or technology-based tools combined with phone-based intervention (TECH + PHONE, n = 27). All participants attended one introductory weight loss session and completed assessments at baseline, 3 months, and 6 months. RESULTS Weight loss from baseline to 6 months differed significantly between groups P = 0.042; there was a trend for TECH + PHONE (-6.4 ± 1.2 kg) to lose more weight than ST (-1.3 ± 1.2 kg); weight loss in TECH (-4.1 ± 1.4 kg) was between ST and TECH + PHONE. Fewer ST (15%) achieved ≥5% weight losses compared with TECH and TECH + PHONE (44%), P = 0.039. Adherence to self-monitoring caloric intake was higher in TECH + PHONE than TECH or ST, Ps < 0.05. CONCLUSIONS These results suggest use of newer self-monitoring technology plus brief phone-based intervention improves adherence and weight loss compared with traditional self-monitoring tools. Further research should determine cost-effectiveness of adding phone-based intervention when providing self-monitoring technology.
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Affiliation(s)
- Kathryn M Ross
- Department of Psychiatry and Human Behavior, Weight Control & Diabetes Research Center, Alpert Medical School of Brown University and the Miriam Hospital, Providence, Rhode Island, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Weight Control & Diabetes Research Center, Alpert Medical School of Brown University and the Miriam Hospital, Providence, Rhode Island, USA
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Sullivan DK, Goetz JR, Gibson CA, Mayo MS, Washburn RA, Lee Y, Ptomey LT, Donnelly JE. A virtual reality intervention (Second Life) to improve weight maintenance: Rationale and design for an 18-month randomized trial. Contemp Clin Trials 2015; 46:77-84. [PMID: 26616535 DOI: 10.1016/j.cct.2015.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
Despite the plethora of weight loss programs available in the US, the prevalence of overweight and obesity (BMI≥25kg/m(2)) among US adults continues to rise at least, in part, due to the high probability of weight regain following weight loss. Thus, the development and evaluation of novel interventions designed to improve weight maintenance are clearly needed. Virtual reality environments offer a promising platform for delivering weight maintenance interventions as they provide rapid feedback, learner experimentation, real-time personalized task selection and exploration. Utilizing virtual reality during weight maintenance allows individuals to engage in repeated experiential learning, practice skills, and participate in real-life scenarios without real-life repercussions, which may diminish weight regain. We will conduct an 18-month effectiveness trial (6 months weight loss, 12 months weight maintenance) in 202 overweight/obese adults (BMI 25-44.9kg/m(2)). Participants who achieve ≥5% weight loss following a 6month weight loss intervention delivered by phone conference call will be randomized to weight maintenance interventions delivered by conference call or conducted in a virtual environment (Second Life®). The primary aim of the study is to compare weight change during maintenance between the phone conference call and virtual groups. Secondarily, potential mediators of weight change including energy and macronutrient intake, physical activity, consumption of fruits and vegetables, self-efficacy for both physical activity and diet, and attendance and completion of experiential learning assignments will also be assessed.
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Affiliation(s)
- D K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J R Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - C A Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - M S Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - R A Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Y Lee
- Department of Educational Leadership and Policy Studies, The University of Kansas, 1122 West Campus Rd., Lawrence, KS 66045-3101, USA.
| | - L T Ptomey
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - J E Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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Nackers LM, Dubyak PJ, Lu X, Anton SD, Dutton GR, Perri MG. Group dynamics are associated with weight loss in the behavioral treatment of obesity. Obesity (Silver Spring) 2015; 23:1563-9. [PMID: 26179461 DOI: 10.1002/oby.21148] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/20/2015] [Accepted: 04/14/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess whether group dynamics are associated with weight loss, session attendance, and self-monitoring adherence after 6 months of lifestyle intervention for obesity. METHODS Women with obesity (N = 125; mean ± SD BMI = 37.84 ± 3.94 kg/m(2) ; age = 51.99 ± 10.81 years) participated in a 24-week group-based lifestyle weight loss intervention and achieved a weight loss of 9.13 ± 7.15 kg after 6 months. Participants reported their perceptions of group conflict, avoidance, engagement, social support, and attraction at the end of treatment. Multiple regression with forward selection assessed which group dynamic variables were associated with weight loss, attendance, and adherence. RESULTS Greater perceived group conflict was associated with smaller weight losses (β = 1.833, P = 0.044) and lower attendance (β = -2.313, P = 0.002) and adherence rates (β = -2.261, P = 0.030). Higher group attraction was associated with higher attendance rates (β = 0.051, P = 0.039). The association between perceived conflict and weight change was mediated by attendance and adherence (P = 0.019). CONCLUSIONS Findings demonstrate that group dynamics associate with weight loss outcomes, attendance, and adherence. Addressing conflicts and fostering acceptance among group members may promote success in group-based lifestyle interventions for obesity.
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Affiliation(s)
- Lisa M Nackers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Pamela J Dubyak
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Xiaomin Lu
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
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Huber JM, Shapiro JS, Wieland ML, Croghan IT, Vickers Douglas KS, Schroeder DR, Hathaway JC, Ebbert JO. Telecoaching plus a portion control plate for weight care management: a randomized trial. Trials 2015; 16:323. [PMID: 26223309 PMCID: PMC4518583 DOI: 10.1186/s13063-015-0880-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/21/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obesity is a leading preventable cause of death and disability and is associated with a lower health-related quality of life. We evaluated the impact of telecoaching conducted by a counselor trained in motivational interviewing paired with a portion control plate for obese patients in a primary care setting. METHODS We conducted a randomized, clinical trial among patients in a primary care practice in the midwestern United States. Patients were randomized to either usual care or an intervention including telecoaching with a portion control plate. The intervention was provided during a 3-month period with follow-up of all patients through 6 months after randomization. The primary outcomes were weight, body mass index (BMI),waist circumference, and waist to hip ratio measured at baseline, 6, 12, 18, and 24 weeks. Secondary outcomes included measures assessing eating behaviors, self-efficacy, and physical activity at baseline and at 12 and 24 weeks. RESULTS A total of 1,101 subjects were pre-screened, and 90 were randomly assigned to telecoaching plus portion control plate (n = 45) or usual care (n = 45). Using last-value carried forward without adjustment for baseline demographics, significant reductions in BMI (estimated treatment effect -0.4 kg/m(2), P = .038) and waist to hip ratio (estimated treatment effect -.02, P = .037) at 3 months were observed in the telecoaching plus portion control plate group compared to usual care. These differences were not statistically significant at 6 months. In females, the telecoaching plus portion control plate intervention was associated with significant reductions in weight and BMI at both 3 months (estimated treatment effect -1.6 kg, P = .016 and -0.6 kg/m(2), P = .020) and 6 months (estimated treatment effect -2.3 kg, P = .013 and -0.8 kg/m(2), P = .025). In males, the telecoaching plus portion control intervention was associated with a significant reduction in waist to hip ratio at 3 months (estimated treatment effect -0.04, P = .017), but failed to show a significant difference in weight and BMI. CONCLUSION Telecoaching with a portion control plate can produce positive change in body habitus among obese primary care patients; however, changes depend upon sex. TRIAL REGISTRATION ClinicalTrials.gov NCT02373878, 13 February 2015. https://clinicaltrials.gov/ct2/show/NCT02373878.
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Affiliation(s)
- Jill M Huber
- Division of Primary Care Internal Medicine, Department of Medicine, Rochester, MN, 55905, USA.
| | - Joshua S Shapiro
- Division of Internal Medicine, Department of Medicine, Rochester, MN, 55905, USA.
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Rochester, MN, 55905, USA.
| | - Ivana T Croghan
- Division of Primary Care Internal Medicine, Department of Medicine, Rochester, MN, 55905, USA.
| | | | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Julie C Hathaway
- Patient Education and Consulting Services, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Department of Medicine, Rochester, MN, 55905, USA.
- Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
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Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, Lee CJ, Bleich SN, Clark JM. Efficacy of commercial weight-loss programs: an updated systematic review. Ann Intern Med 2015; 162:501-12. [PMID: 25844997 PMCID: PMC4446719 DOI: 10.7326/m14-2238] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Commercial and proprietary weight-loss programs are popular obesity treatment options, but their efficacy is unclear. PURPOSE To compare weight loss, adherence, and harms of commercial or proprietary weight-loss programs versus control/education (no intervention, printed materials only, health education curriculum, or <3 sessions with a provider) or behavioral counseling among overweight and obese adults. DATA SOURCES MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014; references identified by program staff. STUDY SELECTION Randomized, controlled trials (RCTs) of at least 12 weeks' duration; prospective case series of at least 12 months' duration (harms only). DATA EXTRACTION Two reviewers extracted information on study design, population characteristics, interventions, and mean percentage of weight change and assessed risk of bias. DATA SYNTHESIS We included 45 studies, 39 of which were RCTs. At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss than those assigned to control/education. Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. Nutrisystem resulted in at least 3.8% greater weight loss at 3 months than control/education and counseling. Very-low-calorie programs (Health Management Resources, Medifast, and OPTIFAST) resulted in at least 4.0% greater short-term weight loss than counseling, but some attenuation of effect occurred beyond 6 months when reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed. We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs. LIMITATION Many trials were short (<12 months), had high attrition, and lacked blinding. CONCLUSION Clinicians could consider referring overweight or obese patients to Weight Watchers or Jenny Craig. Other popular programs, such as Nutrisystem, show promising weight-loss results; however, additional studies evaluating long-term outcomes are needed. PRIMARY FUNDING SOURCE None. ( PROSPERO CRD4201-4007155).
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Affiliation(s)
- Kimberly A. Gudzune
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Ruchi S. Doshi
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Ambereen K. Mehta
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Zoobia W. Chaudhry
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - David K. Jacobs
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Rachit M. Vakil
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Clare J. Lee
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Sara N. Bleich
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Jeanne M. Clark
- From Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health; Welch Center for Prevention, Epidemiology, and Clinical Research; Johns Hopkins Bayview Medical Center; and University of Maryland School of Medicine, Baltimore, Maryland, and Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Anderson JW, Reynolds LR, Bush HM, Rinsky JL, Washnock C. Effect of a Behavioral/Nutritional Intervention Program on Weight Loss in Obese Adults: A Randomized Controlled Trial. Postgrad Med 2015; 123:205-13. [DOI: 10.3810/pgm.2011.09.2476] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Szabo-Reed AN, Breslin FJ, Lynch AM, Patrician TM, Martin LE, Lepping RJ, Powell JN, Yeh HWH, Befort CA, Sullivan D, Gibson C, Washburn R, Donnelly JE, Savage CR. Brain function predictors and outcome of weight loss and weight loss maintenance. Contemp Clin Trials 2014; 40:218-31. [PMID: 25533729 DOI: 10.1016/j.cct.2014.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/09/2014] [Accepted: 12/12/2014] [Indexed: 01/22/2023]
Abstract
Obesity rates are associated with public health consequences and rising health care costs. Weight loss interventions, while effective, do not work for everyone, and weight regain is a significant problem. Eating behavior is influenced by a convergence of processes in the brain, including homeostatic factors and motivational processing that are important contributors to overeating. Initial neuroimaging studies have identified brain regions that respond differently to visual food cues in obese and healthy weight individuals that are positively correlated with reports of hunger in obese participants. While these findings provide mechanisms of overeating, many important questions remain. It is not known whether brain activation patterns change after weight loss, or if they change differentially based on amount of weight lost. Also, little is understood regarding biological processes that contribute to long-term weight maintenance. This study will use neuroimaging in participants while viewing food and non-food images. Functional Magnetic Resonance Imaging will take place before and after completion of a twelve-week weight loss intervention. Obese participants will be followed though a 6-month maintenance period. The study will address three aims: 1. Characterize brain activation underlying food motivation and impulsive behaviors in obese individuals. 2. Identify brain activation changes and predictors of weight loss. 3. Identify brain activation predictors of weight loss maintenance. Findings from this study will have implications for understanding mechanisms of obesity, weight loss, and weight maintenance. Results will be significant to public health and could lead to a better understanding of how differences in brain activation relate to obesity.
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Affiliation(s)
- Amanda N Szabo-Reed
- Department of Internal Medicine, University of Kansas Medical Center, United States
| | - Florence J Breslin
- Center for Health Behavior Neuroscience, University of Kansas Medical Center, United States
| | - Anthony M Lynch
- Department of Internal Medicine, University of Kansas Medical Center, United States
| | - Trisha M Patrician
- Center for Health Behavior Neuroscience, University of Kansas Medical Center, United States
| | - Laura E Martin
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, United States; Holgund Brain Imaging Center, University of Kansas Medical Center, United States
| | - Rebecca J Lepping
- Holgund Brain Imaging Center, University of Kansas Medical Center, United States
| | - Joshua N Powell
- Center for Health Behavior Neuroscience, University of Kansas Medical Center, United States
| | - Hung-Wen Henry Yeh
- Department of Biostatistics, University of Kansas Medical Center, United States
| | - Christie A Befort
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, United States
| | - Debra Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, United States
| | - Cheryl Gibson
- Department of Internal Medicine, University of Kansas Medical Center, United States
| | - Richard Washburn
- Department of Internal Medicine, University of Kansas Medical Center, United States
| | - Joseph E Donnelly
- Department of Internal Medicine, University of Kansas Medical Center, United States
| | - Cary R Savage
- Center for Health Behavior Neuroscience, University of Kansas Medical Center, United States.
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27
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Dutton GR, Laitner MH, Perri MG. Lifestyle interventions for cardiovascular disease risk reduction: a systematic review of the effects of diet composition, food provision, and treatment modality on weight loss. Curr Atheroscler Rep 2014; 16:442. [PMID: 25092578 PMCID: PMC4157951 DOI: 10.1007/s11883-014-0442-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of this systematic review was to evaluate, synthesize, and interpret findings from recent randomized controlled trials (RCTs) of dietary and lifestyle weight loss interventions examining the effects of (1) diet composition, (2) use of food provision, and (3) modality of treatment delivery on weight loss. Trials comparing different dietary approaches indicated that reducing carbohydrate intake promoted greater initial weight loss than other approaches but did not appear to significantly improve long-term outcomes. Food provision appears to enhance adherence to reduction in energy intake and produce greater initial weight losses. The long-term benefits of food provision are less clear. Trials comparing alternative treatment modalities suggest that phone-based treatment produce short- and long-term weight reductions equivalent to face-to-face interventions. The use of Internet and mobile technologies are associated with smaller reductions in body weight than face-to-face interventions. Based on this review, clinical implications and future research directions are provided.
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Affiliation(s)
- Gareth R Dutton
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35216, USA,
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28
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Harris MN, Swift DL, Myers VH, Earnest CP, Johannsen NM, Champagne CM, Parker BD, Levy E, Cash KC, Church TS. Cancer survival through lifestyle change (CASTLE): a pilot study of weight loss. Int J Behav Med 2014; 20:403-12. [PMID: 22535636 DOI: 10.1007/s12529-012-9234-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Excess weight is a strong predictor of incident breast cancer (BC) and survivorship. A limited number of studies comparing strategies for promoting successful weight loss in women with remitted BC exist. PURPOSE CASTLE was a pilot study comparing the effectiveness/feasibility of in-person and telephonic behavioral-based lifestyle weight loss interventions in BC survivors. METHOD Fifty-two overweight/obese women (BMI = 25-45 kg/m(2)) with remitted BC (stages I-IIIa) who recently completed cancer treatment were assigned to either an in-person group (n = 24) or an individual telephone-based condition (n = 11). Both interventions focused on increasing physical activity and reducing caloric intake. The phase I intervention lasted 6 months. The in-person condition received 16 group-based sessions, and the telephone condition received intervention calls approximately weekly. Phase II lasted 6 months (e.g., months 6-12), and all participants received monthly intervention calls via telephone. RESULTS Participants were predominately Caucasian (80 %) with a mean age of 52.8 (8.0) years and BMI of 31.9 (5.4) kg/m(2). Mixed models ANOVAs showed significant within group weight loss after 6 months for both the in-person (-3.3 kg ± 4.4, p = 0.002) and the telephonic (-4.0 kg ± 6.0, p = 0.01) conditions with no between group differences. During phase II, the in-person group demonstrated significant weight regain (1.3 kg ± 1.7, p = 0.009). CONCLUSION Our pilot study findings demonstrated that telephone-based behavioral weight loss programs are effective and feasible in BC survivors and that telephonic programs may have advantages in promoting weight loss maintenance.
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Affiliation(s)
- Melissa Nauta Harris
- Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808-4124, USA
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John E, Cassidy DM, Playle R, Jewell K, Cohen D, Duncan D, Newcombe RG, Busse M, Owen-Jones E, Williams N, Longo M, Avery A, Simpson SA. Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy. BMC Public Health 2014; 14:439. [PMID: 24886352 PMCID: PMC4018969 DOI: 10.1186/1471-2458-14-439] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity. This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women’s Body Mass Index at 12 months following birth. Methods/design The study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m2) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum. Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted. Discussion This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child. Trial registration Current Controlled Trials: ISRCTN25260464 Date of registration: 16th April 2010.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sharon A Simpson
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
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Befort CA, Klemp JR, Fabian C, Perri MG, Sullivan DK, Schmitz KH, Diaz FJ, Shireman T. Protocol and recruitment results from a randomized controlled trial comparing group phone-based versus newsletter interventions for weight loss maintenance among rural breast cancer survivors. Contemp Clin Trials 2014; 37:261-71. [PMID: 24486636 PMCID: PMC3992482 DOI: 10.1016/j.cct.2014.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/21/2014] [Accepted: 01/24/2014] [Indexed: 01/12/2023]
Abstract
Obesity is a risk factor for breast cancer recurrence and death. Women who reside in rural areas have higher obesity prevalence and suffer from breast cancer treatment-related disparities compared to urban women. The objective of this 5-year randomized controlled trial is to compare methods for delivering extended care for weight loss maintenance among rural breast cancer survivors. Group phone-based counseling via conference calls addresses access barriers, is more cost-effective than individual phone counseling, and provides group support which may be ideal for rural breast cancer survivors who are more likely to have unmet support needs. Women (n=210) diagnosed with Stage 0 to III breast cancer in the past 10 years who are ≥ 3 months out from initial cancer treatments, have a BMI 27-45 kg/m(2), and have physician clearance were enrolled from multiple cancer centers. During Phase I (months 0 to 6), all women receive a behavioral weight loss intervention delivered through group phone sessions. Women who successfully lose 5% of weight enter Phase II (months 6 to 18) and are randomized to one of two extended care arms: continued group phone-based treatment or a mail-based newsletter. During Phase III, no contact is made (months 18 to 24). The primary outcome is weight loss maintenance from 6 to 18 months. Secondary outcomes include quality of life, serum biomarkers, and cost-effectiveness. This study will provide essential information on how to reach rural survivors in future efforts to establish weight loss support for breast cancer survivors as a standard of care.
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Affiliation(s)
- Christie A. Befort
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Jennifer R. Klemp
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Carol Fabian
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | | | - Debra K. Sullivan
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Kathryn H. Schmitz
- University of Pennsylvania, Perelman School of Medicine 423 Guardian Drive, Philadelphia, PA 19104
| | - Francisco J. Diaz
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
| | - Theresa Shireman
- University of Kansas Medical Center 3901 Rainbow Blvd, Kansas City, KS, USA ; ; ;
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Comparison of two self-directed weight loss interventions: Limited weekly support vs. no outside support. Obes Res Clin Pract 2013; 3:I-IV. [PMID: 24345585 DOI: 10.1016/j.orcp.2009.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 04/01/2009] [Accepted: 04/01/2009] [Indexed: 11/23/2022]
Abstract
SUMMARY OBJECTIVE The purpose of this study was to compare the efficacy of two home-based weight loss interventions that differ only in the amount of outside support provided. METHODS This was a 12-week, randomized, controlled trial. One group received limited support (LWS, n = 35) via a single 10 min phone call each week while another group received no weekly support (NWS, n = 28). Both the LWS and NWS received pre-packaged meals (PM) and shakes. A third group served as control (CON, n = 30) and received no components of the intervention. Weight loss at 12 weeks was the primary outcome. Diet (PM, shake, and fruit/vegetable (F/V) intake) and physical activity (PA) were self-monitored, recorded daily and reported weekly. An exit survey was completed by participants in the intervention groups upon completion of the study. RESULTS Weight loss and percent weight loss in the LWS, NWS, and CON groups were 7.7 ± 4.4 kg (8.5 ± 4.2%), 5.9 ± 4.1 kg (6.0 ± 4.2%), and 0.3 ± 1.9 kg (0.4 ± 1.2%), respectively. The decrease in body weight and percent weight loss was significantly greater in the LWS and NWS groups when compared to the CON group and the percent weight loss was significantly greater in the LWS when compared to both the NWS and CON groups. CONCLUSION A home-based weight loss program utilizing PM and shakes results in clinically significant percent weight loss and the addition of a brief weekly call promotes additional percent weight loss.
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Goode A, Reeves M, Owen N, Eakin E. Results from the dissemination of an evidence-based telephone-delivered intervention for healthy lifestyle and weight loss: the Optimal Health Program. Transl Behav Med 2013; 3:340-50. [PMID: 24294322 DOI: 10.1007/s13142-013-0210-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Despite proven efficacy, there are few published evaluations of telephone-delivered interventions targeting physical activity, healthy eating, and weight loss in community dissemination contexts. This study aims to evaluate participant and program outcomes from the Optimal Health Program, a telephone-delivered healthy lifestyle and weight loss program provided by a primary health care organization. Dissemination study used a single-group, repeated measures design; outcomes were assessed at 6-month (mid-program; n = 166) and 12-month (end of program; n = 88) using paired analyses. The program reached a representative sample of at-risk, primary care patients, with 56 % withdrawing before program completion. Among completers, a statistically significant improvement between baseline and end of program was observed for weight [mean change (SE) -5.4 (7.0) kg] and waist circumference [-4.8 (9.7) cm], underpinned by significant physical activity and dietary change. Findings suggest that telephone-delivered weight loss and healthy lifestyle programs can provide an effective model for use in primary care settings, but participant retention remains a challenge.
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Affiliation(s)
- Ana Goode
- Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Herston Rd., Herston, Queensland 4006 Australia
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Capsule Commentary on Weinstock et al., Weight loss success in metabolic syndrome by telephone interventions: results from the SHINE Study. J Gen Intern Med 2013; 28:1645. [PMID: 23897127 PMCID: PMC3832721 DOI: 10.1007/s11606-013-2539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Donnelly JE, Washburn RA, Sullivan DK, Honas JJ, Mayo MS, Goetz J, Lee J, Szabo AN. The Midwest Exercise Trial for the Prevention of Weight Regain: MET POWeR. Contemp Clin Trials 2013; 36:470-8. [PMID: 24012915 PMCID: PMC3844028 DOI: 10.1016/j.cct.2013.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/22/2013] [Accepted: 08/24/2013] [Indexed: 11/19/2022]
Abstract
Weight reduction in overweight and obese individuals results in physiological and behavioral changes that make the prevention of weight regain more difficult than either initial weight loss or the prevention of weight gain. Exercise is recommended for the prevention of weight regain by both governmental agencies and professional organizations. To date, the effectiveness of exercise recommendations for the prevention of weight regain has not been evaluated in a properly designed, adequately powered trial. Therefore, we will conduct a randomized trial to evaluate the effectiveness of 3 levels of exercise on the prevention of weight regain, in initially overweight and obese sedentary men and women. Participants will complete a 3 month weight loss intervention of decreased energy intake (EI) and increased exercise (100 min/week). Participants achieving clinically significant weight loss (≥ 5% of initial weight), will then be randomly assigned to 12 months of verified exercise at 3 levels (150, 225 or 300 min/week). This study will evaluate: 1) the effectiveness of 3 levels of exercise on the prevention of weight regain over 12 months subsequent to clinically significant weight loss (≥ 5%); 2) gender differences in weight regain in response to 3 levels of exercise; and 3) potential compensatory changes in daily physical activity (PA) and EI on weight regain in response to the 3 levels of exercise. The results of this investigation will provide information to develop evidence-based recommendations for the level of exercise associated with the prevention of weight regain.
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Affiliation(s)
- Joseph E. Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Richard A. Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Debra K. Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jeffery J. Honas
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Matthew S. Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jeannine Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jaehoon Lee
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Amanda N. Szabo
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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Fabian CJ, Kimler BF, Donnelly JE, Sullivan DK, Klemp JR, Petroff BK, Phillips TA, Metheny T, Aversman S, Yeh HW, Zalles CM, Mills GB, Hursting SD. Favorable modulation of benign breast tissue and serum risk biomarkers is associated with > 10 % weight loss in postmenopausal women. Breast Cancer Res Treat 2013; 142:119-32. [PMID: 24141897 PMCID: PMC3921968 DOI: 10.1007/s10549-013-2730-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/05/2013] [Indexed: 12/25/2022]
Abstract
We conducted a phase II feasibility study of a 6-month behavioral weight loss intervention in postmenopausal overweight and obese women at increased risk for breast cancer and the effects of weight loss on anthropomorphic, blood, and benign breast tissue biomarkers. 67 women were screened by random peri-areolar fine-needle aspiration, 27 were registered and 24 participated in the interventional phase. The 24 biomarker evaluable women had a median baseline BMI of 34.2 kg/m(2) and lost a median of 11 % of their initial weight. Significant tissue biomarker modulation after the 6-month intervention was noted for Ki-67 (if restricted to the 15 women with any Ki-67 at baseline, p = 0.041), adiponectin to leptin ratio (p = 0.003); and cyclin B1 (p = 0.001), phosphorylated retinoblastoma (p = 0.005), and ribosomal S6 (p = 0.004) proteins. Favorable modulation for serum markers was observed for sex hormone-binding globulin (p < 0.001), bioavailable estradiol (p < 0.001), bioavailable testosterone (p = 0.033), insulin (p = 0.018), adiponectin (p = 0.001), leptin (p < 0.001), the adiponectin to leptin ratio (p < 0.001), C-reactive protein (p = 0.002), and hepatocyte growth factor (p = 0.011). When subdivided by <10 or >10 % weight loss, change in percent total body and android (visceral) fat, physical activity, and the majority of the serum and tissue biomarkers were significantly modulated only for women with >10 % weight loss from baseline. Some factors such as serum PAI-1 and breast tissue pS2 (estrogen-inducible gene) mRNA were not significantly modulated overall but were when considering only those with >10 % weight loss. In conclusion, a median weight loss of 11 % over 6 months resulted in favorable modulation of a number of anthropomorphic, breast tissue and serum risk and mechanistic markers. Weight loss of 10 % or more should likely be the goal for breast cancer risk reduction studies in obese women.
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Affiliation(s)
- Carol J Fabian
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA,
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Donnelly JE, Goetz J, Gibson C, Sullivan DK, Lee R, Smith BK, Lambourne K, Mayo MS, Hunt S, Lee JH, Honas JJ, Washburn RA. Equivalent weight loss for weight management programs delivered by phone and clinic. Obesity (Silver Spring) 2013; 21:1951-9. [PMID: 23408579 PMCID: PMC4442605 DOI: 10.1002/oby.20334] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/08/2012] [Accepted: 12/12/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Face-to-face (FTF) weight management is costly and presents barriers for individuals seeking treatment; thus, alternate delivery systems are needed. The objective of this study was to compare weight management delivered by FTF clinic or group conference calls (phone). DESIGN AND METHODS Randomized equivalency trial in 295 overweight/obese men/women (BMI = 35.1±4.9, Age = 43.8±10.2, Minority = 39.8%). Weight loss (0-6 months) was achieved by reducing energy intake between 1,200 and 1,500 kcal/day and progressing physical activity (PA) to 300 min/week. Weight maintenance (7-18 months) provided adequate energy to maintain weight and continued 300 min/week of PA. Behavioral weight management strategies were delivered weekly for 6 months and gradually reduced during 7-18 months. A cost analysis provided a comparison of expenses between groups. RESULTS Weight change from baseline to 6 months was -13.4 ± 6.7% and -12.3 ± 7.0% for FTF clinic and phone, respectively. Weight change from 6-18 months was 6.4 ± 7.0% and 6.4 ± 5.2%, for FTF clinic and phone, respectively. The cost to FTF participants was $789.58 more per person. CONCLUSIONS Phone delivery provided equivalent weight loss and maintenance and reduced program cost. Ubiquitous access to phones provides a vast reach for this approach.
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Affiliation(s)
- Joseph E. Donnelly
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jeannine Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Cheryl Gibson
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Debra K. Sullivan
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Robert Lee
- Department of Health Policy and Management, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Bryan K. Smith
- Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Vadalabene Center, Box 1126, Edwardsville, IL, 62026 USA
| | - Kate Lambourne
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Matthew S. Mayo
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Suzanne Hunt
- Department of Biostatistics, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Jae Hoon Lee
- Center for Research Methods and Data Analysis, The University of Kansas, 1425 Jayhawk Blvd., Room 470, Lawrence, KS 66045 USA
| | - Jeffrey J. Honas
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Richard A. Washburn
- Cardiovascular Research Institute, Division of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
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Russell HA, Rufus C, Fogarty CT, Fiscella K, Carroll J. 'You need a support. When you don't have that . . . chocolate looks real good'. Barriers to and facilitators of behavioural changes among participants of a Healthy Living Program. Fam Pract 2013; 30:452-8. [PMID: 23515375 PMCID: PMC3722507 DOI: 10.1093/fampra/cmt009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Health behavioural change is complex, especially for underserved patients who have higher rates of obesity and physical inactivity. Behavioural change interventions that show high efficacy in clinical trials may be difficult to disseminate and may not be effective in the office. OBJECTIVE We sought to identify factors that facilitate or hinder behavioural change among past participants of a healthy lifestyle intervention in an urban underserved health centre. METHODS Between March and October 2011, we conducted five focus group sessions with a total of 23 past participants. The focus group transcripts were analysed with a framework approach using the Social Ecological Model as a coding structure. RESULTS We found four interconnected levels of social contexts: individual, interpersonal, programmatic and community levels. Themes of social support and the importance of relationships for making and maintaining behavioural changes were found at all levels. CONCLUSION Social support and relatedness were key facilitators of healthy lifestyle changes and influenced individual motivation and perseverance. Harnessing the power of social support and motivation may be a way for future behavioural change interventions to bridge the gap between efficacy and effectiveness.
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Affiliation(s)
- Holly Ann Russell
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, 777 South Clinton Avenue, Rochester, NY 14620, USA.
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38
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Berkowitz RI, Rukstalis MR, Bishop-Gilyard CT, Moore RH, Gehrman CA, Xanthopoulos MS, Cochran WJ, Louden D, Wadden TA. Treatment of adolescent obesity comparing self-guided and group lifestyle modification programs: a potential model for primary care. J Pediatr Psychol 2013; 38:978-86. [PMID: 23750019 DOI: 10.1093/jpepsy/jst035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lifestyle modification programs (LMP) for weight loss in adolescents with obesity are effective but not available. Primary care may be a setting for reaching more adolescents. Two models of LMP for use in primary care were examined. Adolescents and caregivers enrolled in a 1-year randomized trial comparing Group LMP with Self-Guided LMP. All participants (N = 169) received the same treatment recommendations and met with a health coach six times in clinic. Group LMP participants had an additional 17 group sessions; those in Self-Guided LMP followed the remainder of the program at home with parental support. The primary outcome was percentage change in initial body mass index. The mean (SE) 1.31% (0.95%) reduction in Group LMP did not differ significantly from the 1.17% (0.99%) decrease in the Self-Guided LMP (p = 0.92). Both treatments were significantly effective in reducing body mass index. Given its brevity, the Self-Guided LMP offers an innovative approach for primary care.
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Affiliation(s)
- Robert I Berkowitz
- MD, The Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA.
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Sullivan DK, Goetz JR, Gibson CA, Washburn RA, Smith BK, Lee J, Gerald S, Fincham T, Donnelly JE. Improving weight maintenance using virtual reality (Second Life). JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:264-268. [PMID: 23622351 DOI: 10.1016/j.jneb.2012.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 10/24/2012] [Accepted: 10/28/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Compare weight loss and maintenance between a face-to-face (FTF) weight management clinic and a clinic delivered via virtual reality (VR). METHODS Participants were randomized to 3 months of weight loss with a weekly clinic delivered via FTF or VR and then 6 months' weight maintenance delivered with VR. Data were collected at baseline and 3 and 6 months for weight and process variables. Twenty overweight and obese individuals (31.1 ± 3.6 years of age; body mass index, 32.8 ± 5.1; 85% females; 20% minorities) responded to advertisement and met inclusion criteria. Diets (1,200-1,800 kcal/d) used prepackaged meals, fruits and vegetables, and physical activity (300 min/wk). RESULTS Weight loss was significantly greater for FTF at 10.8% compared with 7.6% for VR (P < .05). However, weight maintenance was significantly greater for VR at 14.0% compared with 9.5% for FTF (P < .05). CONCLUSIONS AND IMPLICATIONS Virtual reality compares favorably with FTF for weight loss and may facilitate greater weight maintenance.
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Affiliation(s)
- Debra K Sullivan
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Carvajal R, Wadden TA, Tsai AG, Peck K, Moran CH. Managing obesity in primary care practice: a narrative review. Ann N Y Acad Sci 2013; 1281:191-206. [PMID: 23323827 PMCID: PMC3618542 DOI: 10.1111/nyas.12004] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This narrative review examines randomized controlled trials of the management of obesity in primary care practice, in light of the Centers for Medicare and Medicaid Services’ decision to support intensive behavioral weight loss counseling provided by physicians and related health professionals. Mean weight losses of 0.1–2.3 kg were observed with brief (10- to 15-min) behavioral counseling delivered by primary care providers (PCPs) at monthly to quarterly visits. Losses increased to 1.7–7.5 kg when brief PCP counseling was combined with weight loss medication. Collaborative treatment, in which medical assistants delivered brief monthly behavioral counseling in conjunction with PCPs, produced losses of 1.6–4.6 kg in periods up to two years. Remotely delivered, intensive (>monthly contact) behavioral counseling, as offered by telephone, yielded losses of 0.4–5.1 kg over the same period. Further study is needed of the frequency and duration of visits required to produce clinically meaningful weight loss (>5%) in primary care patients. In addition, trials are needed that examine the cost-effectiveness of PCP-delivered counseling, compared with that potentially provided by registered dietitians or well-studied commercial programs.
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Affiliation(s)
- Raymond Carvajal
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Ritter S, Vetter ML, Sarwer DB. Lifestyle modifications and surgical options in the treatment of patients with obesity and type 2 diabetes mellitus. Postgrad Med 2012; 124:168-80. [PMID: 22913905 DOI: 10.3810/pgm.2012.07.2578] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article reviews recent developments in the behavioral and surgical treatment of obesity and type 2 diabetes mellitus (T2DM). Randomized controlled trials of comprehensive lifestyle-modification programs, which include dietary interventions, physical activity, and behavioral therapy, have shown weight losses of 7% to 10% of initial body weight within 4 to 6 months after treatment. These programs also reduce the likelihood of developing T2DM by 58% for individuals with impaired glucose tolerance. Long-term maintenance of these improvements requires continued implementation of the program diet, physical activity, and self-regulatory behaviors. This can be successfully facilitated by continued patient-provider contact, which is frequently delivered by phone, mail, email, or online. However, these benefits may have less impact on those with extreme obesity or more significant health problems. For these individuals, bariatric surgery may be a more appropriate treatment. Bariatric surgical procedures induce mean weight losses of 15% to 30% of initial body weight (depending on the procedure) within 2 years after surgery, as well as a 45% to 95% rate of diabetes remission. Familiarity with these developments can help physicians and patients to determine which combinations of behavioral, medical, and surgical interventions are appropriate for the treatment of obesity and T2DM.
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Affiliation(s)
- Scott Ritter
- Center for Weight and Eating Disorders and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Weight management by phone conference call: a comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial. Contemp Clin Trials 2012; 33:1044-55. [PMID: 22664647 DOI: 10.1016/j.cct.2012.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/18/2012] [Accepted: 05/19/2012] [Indexed: 11/21/2022]
Abstract
State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25-39.9 kg/m(2)) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed.
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Cahill JM, Freeland-Graves JH, Shah BS, Lu H, Pepper MR. Determinants of Weight Loss after an Intervention in Low-Income Women in Early Postpartum. J Am Coll Nutr 2012; 31:133-43. [DOI: 10.1080/07315724.2012.10720019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation 2012; 125:1157-70. [PMID: 22392863 PMCID: PMC3313649 DOI: 10.1161/circulationaha.111.039453] [Citation(s) in RCA: 360] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Thomas A Wadden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, Kumanyika S, Schmitz KH, Diewald LK, Barg R, Chittams J, Moore RH. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med 2011; 365:1969-79. [PMID: 22082239 PMCID: PMC3282598 DOI: 10.1056/nejmoa1109220] [Citation(s) in RCA: 347] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Calls for primary care providers (PCPs) to offer obese patients behavioral weight-loss counseling have not been accompanied by adequate guidance on how such care could be delivered. This randomized trial compared weight loss during a 2-year period in response to three lifestyle interventions, all delivered by PCPs in collaboration with auxiliary health professionals (lifestyle coaches) in their practices. METHODS We randomly assigned 390 obese adults in six primary care practices to one of three types of intervention: usual care, consisting of quarterly PCP visits that included education about weight management; brief lifestyle counseling, consisting of quarterly PCP visits combined with brief monthly sessions with lifestyle coaches who instructed participants about behavioral weight control; or enhanced brief lifestyle counseling, which provided the same care as described for the previous intervention but included meal replacements or weight-loss medication (orlistat or sibutramine), chosen by the participants in consultation with the PCPs, to potentially increase weight loss. RESULTS Of the 390 participants, 86% completed the 2-year trial, at which time, the mean (±SE) weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success (P=0.003 and P=0.02, respectively), with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given sibutramine were excluded from the analyses. There were no significant differences between the intervention groups in the occurrence of serious adverse events. CONCLUSIONS Enhanced weight-loss counseling helps about one third of obese patients achieve long-term, clinically meaningful weight loss. (Funded by the National Heart, Lung, and Blood Institute; POWER-UP ClinicalTrials.gov number, NCT00826774.).
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Affiliation(s)
- Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis 2011; 7:644-51. [PMID: 21962227 DOI: 10.1016/j.soard.2011.06.016] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 06/01/2011] [Accepted: 06/28/2011] [Indexed: 11/19/2022]
Abstract
During the past decade, bariatric surgery has become an increasingly popular treatment option for the growing number of individuals with extreme obesity. For most individuals, the size and durability of the weight loss and improvements in co-morbidity and mortality have far surpassed those typically seen with behavioral modification and pharmacotherapy. A significant minority of patients, however, will experience suboptimal outcomes, including less than expected weight loss, premature weight regain, and frequent vomiting and/or gastric dumping. The reasons for these outcomes are not well understood, but likely involve both behavioral and physiologic processes. The present review highlights current knowledge on the changes in dietary intake and eating behavior that occur after bariatric surgery in terms of the potential threats these changes might pose to long-term postoperative success. The paper also identifies several strategies from the nonsurgical weight loss literature that might help optimize long-term weight maintenance after surgery.
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Affiliation(s)
- David B Sarwer
- Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Terry PE, Seaverson ELD, Grossmeier J, Anderson DR. Effectiveness of a worksite telephone-based weight management program. Am J Health Promot 2011; 25:186-9. [PMID: 21192748 DOI: 10.4278/ajhp.081112-quan-281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Examine the long-term impact of a telephone-based weight management program among participants recruited from worksite settings. DESIGN Pre/post quasi-experimental design comparing weight loss and related behaviors between program completers and noncompleters. SETTING Ten large private-sector and public-sector employers. SUBJECTS Overweight or obese participants (n = 1298) enrolled in a telephone-based weight management program. INTERVENTION Individually tailored telephone-based weight management coaching program that included up to five calls over a median of 250 days. MEASURES Weight, body mass index, and lifestyle behaviors assessed via health risk assessment at baseline and 1-year follow-up. ANALYSIS Chi-square and one-way analysis of variance procedures were used to assess between-group differences in weight and associated behaviors, with criterion for significance set at p < .05. RESULTS Among weight management program participants, 48% of program completers and 47% of noncompleters lost weight, but program completers averaged 2.6 times more weight loss than noncompleters. Improvements in physical activity, eating habits, and overall health status were reported for completers. CONCLUSION The weight loss attained among participants who lost weight, along with the improvements in physical activity and nutrition practices, suggests that a telephone-based weight management program of modest intensity can have a positive impact on the health of obese or overweight worksite participants.
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Affiliation(s)
- Paul E Terry
- StayWell Health Management, Saint Paul, Minnesota 55121, USA
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Wadden TA, Fujioka K, Toubro S, Gantz I, Erondu NE, Chen M, Suryawanshi S, Carofano W, Johnson-Levonas AO, Shapiro DR, Kaufman KD, Heymsfield SB, Amatruda JM. A randomized trial of lifestyle modification and taranabant for maintaining weight loss achieved with a low-calorie diet. Obesity (Silver Spring) 2010; 18:2301-10. [PMID: 20379151 PMCID: PMC5708144 DOI: 10.1038/oby.2010.67] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Improving the maintenance of weight loss remains a critical challenge for obesity researchers. The present 1-year, randomized, placebo-controlled trial evaluated the safety and efficacy of weight maintenance counseling combined with either placebo or the cannabinoid-1 receptor inverse agonist, taranabant, for sustaining prior weight loss achieved on a low-calorie diet (LCD). Seven hundred eighty-four individuals who had lost ≥ 6% of body weight during six initial weeks of treatment with an 800 kcal/day liquid LCD were randomly assigned to placebo or once-daily taranabant in doses of 0.5, 1, or 2 mg. All participants were provided monthly, on-site behavioral weight maintenance counseling, as well as monthly phone calls. The primary end point was change in body weight from randomization to week 52. The randomized participants lost an average of 9.6 kg (9.5% of initial weight) during the 6-week LCD. The model-adjusted mean change in body weight during the subsequent 1 year was +1.7 kg for placebo, compared with -0.1, -0.6, and -1.2 kg for the taranabant 0.5, 1, and 2 mg doses, respectively (all P values ≤ 0.007 vs. placebo). The incidences of psychiatric-related adverse events, including irritability, were higher for taranabant 1 and 2 mg vs. placebo (P ≤ 0.038). In addition to reporting data on the safety and efficacy of taranabant, this study provides a method for studying the combination of lifestyle modification and pharmacotherapy for weight maintenance after diet-induced weight loss.
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Affiliation(s)
- Thomas A Wadden
- University of Pennsylvania School of Medicine, Department of Psychiatry, Center for Weight and Eating Disorders, Philadelphia, Pennsylvania, USA.
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Tsai AG, Wadden TA, Rogers MA, Day SC, Moore RH, Islam BJ. A primary care intervention for weight loss: results of a randomized controlled pilot study. Obesity (Silver Spring) 2010; 18:1614-8. [PMID: 20019680 DOI: 10.1038/oby.2009.457] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most primary care providers (PCPs), constrained by time and resources, cannot provide intensive behavioral counseling for obesity. This study evaluated the effect of using medical assistants (MAs) as weight loss counselors. The study was a randomized controlled trial conducted in two primary care offices at an academic medical center. Patients (n = 50) had a BMI of 27-50 kg/m(2) and no contraindications to weight loss. They were randomized to quarterly PCP visits and weight loss materials (Control group) or to the same approach combined with eight visits with a MA over 6 months (Brief Counseling). Outcomes included change in weight and cardiovascular risk factors (glucose, lipids, blood pressure, and waist circumference). Patients in the Brief Counseling and Control groups lost 4.4 +/- 0.6 kg (5.1 +/- 0.7% of initial weight) and 0.9 +/- 0.6 kg (1.0 +/- 0.7%), respectively, at month 6 (P < 0.001). There were no significant differences between groups for changes in cardiovascular risk factors. Brief Counseling patients regained weight between month 6 and month 12, when MA visits were discontinued. Attrition was 10% after 6 months and 6% after 12 months. Brief Counseling by MAs induced significant weight loss during 6 months. Office-based obesity treatment should be tested in larger trials and should include weight loss maintenance counseling.
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Affiliation(s)
- Adam G Tsai
- Division of General Internal Medicine & Center for Human Nutrition, University of Colorado Denver, Denver, Colorado, USA.
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Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people. Cochrane Database Syst Rev 2010:CD000984. [PMID: 20238311 PMCID: PMC4235843 DOI: 10.1002/14651858.cd000984.pub2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prevalence of obesity is increasing globally and will, if left unchecked, have major implications for both population health and costs to health services. OBJECTIVES To assess the effectiveness of strategies to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people. SEARCH STRATEGY We updated the search for primary studies in the following databases, which were all interrogated from the previous (version 2) search date to May 2009: The Cochrane Central Register of Controlled Trials (which at this time incorporated all EPOC Specialised Register material) (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid). We identified further potentially relevant studies from the reference lists of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in overweight or obese adults. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. MAIN RESULTS We included six RCTs, involving more than 246 health professionals and 1324 overweight or obese patients. Four of the trials targeted professionals and two targeted the organisation of care. Most of the studies had methodological or reporting weaknesses indicating a risk of bias.Meta-analysis of three trials that evaluated educational interventions aimed at GPs suggested that, compared to standard care, such interventions could reduce the average weight of patients after a year (by 1.2 kg, 95% CI -0.4 to 2.8 kg); however, there was moderate unexplained heterogeneity between their results (I(2) = 41%). One trial found that reminders could change doctors' practice, resulting in a significant reduction in weight among men (by 11.2 kg, 95% CI 1.7 to 20.7 kg) but not among women (who reduced weight by 1.3 kg, 95% CI -4.1 to 6.7 kg). One trial found that patients may lose more weight after a year if the care was provided by a dietitian (by 5.6 kg, 95% CI 4.8 to 6.4 kg) or by a doctor-dietitian team (by 6 kg, 95% CI 5 to 7 kg), as compared with standard care. One trial found no significant difference between standard care and either mail or phone interventions in reducing patients' weight. AUTHORS' CONCLUSIONS Most of the included trials had methodological or reporting weaknesses and were heterogeneous in terms of participants, interventions, outcomes, and settings, so we cannot draw any firm conclusions about the effectiveness of the interventions. All of the evaluated interventions would need further investigation before it was possible to recommend them as effective strategies.
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Affiliation(s)
- Gerd Flodgren
- Department of Public Health, University of Oxford, Headington, UK
| | - Katherine Deane
- Edith Cavell Building, University of East Anglia, Norwich, UK
| | - Heather O Dickinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sara Kirk
- School of Health Administration, Dalhousie University, Halifax, Canada
| | | | - Fiona R Beyer
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James G Brown
- NHS Clinical Knowledge Summaries, Sowerby Centre for Health Informatics at Newcastle, Newcastle upon Tyne, UK
| | - Tarra L Penney
- Applied Research Collaborations for Health, Health Administration, Dalhousie University, Halifax, Canada
| | - Carolyn D Summerbell
- School of Medicine and Health, Wolfson Research Institute, Queen’s Campus, Durham University, Stockton-on-Tees, UK
| | - Martin P Eccles
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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